Resection of the inferior vena cava (IVC) for malignancy is a technically demanding procedure. We present a series of six cases of resection of the IVC for retroperitoneal sarcomas, four of which were primary caval tumors. We outline the technical difficulties faced in these complex procedures and discuss the oncological outcomes of these rare tumors. We performed a retrospective review of six patients operated for retroperitoneal masses involving the inferior vena cava between April 2015 and July 2016 at our tertiary care institute. Six patients underwent resection of the IVC, three of which required a multivisceral resection. An artificial prosthesis was used to reconstruct the IVC in three patients, whereas two patients underwent primary repair of the vein wall. One patient did not require any reconstruction. Margins were microscopically positive in two out of six patients. All patients received radiotherapy, either in the neo-adjuvant or adjuvant setting. Two patients developed local recurrences with a median follow-up of 24.5 months. Resection of the IVC for extirpation of retroperitoneal sarcomas is a technically complex and difficult procedure. The availability of a multidisciplinary team of surgeons and state-of-the-art intensive care support is essential for good outcomes.

Minimally invasive approaches can be used safely for total pelvic exenteration in locally advanced lower rectal adenocarcinoma. All patients had fast recovery with less blood loss. In all patients R0 resection was achieved with adequate margins. Long-term oncological outcomes are still uncertain and will require further follow-up.

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Outcomes of sphincter preserving surgery for distal rectal cancers improve with clear circumferential resection and distal resection margin. However, the extent of distal resection margin after a complete mesorectal excision is often a cause for debate. We evaluated the outcome of middle and lower third rectal cancer patients undergoing sphincter preservation with variable distal resection margin at our center. Patients with biopsy-proven rectal adenocarcinoma within 10 cm from anal verge undergoing sphincter preserving resections were included. Patients with positive circumferential resection margin were excluded. Patients were divided into three groups based on the extent of distal resection margin (< 6 mm, 6-10 mm, > 10 mm) and oncological outcomes were compared. The median age of 242 patients was 50 years and 44 (18.2%) were high-grade tumors. Preoperative chemoradiation was used in 185 (75.2%) patients. Median distal resection margin was 20 mm. Patients in < 10 mm group had a significantly higher proportion of lower third (68.3% vs 39.8%, p = 0.004) and chemoradiation-treated tumors (85.4 vs 74.6%, p = 0.001). A significantly higher percentage required an intersphincteric resection in the < 10 mm group (53.7% vs 14.4%, p = 0.0001). Significantly higher percentage tumors were pT3 in > 10 mm group (45.3% vs. 31.7%) (p = 0.05). The median follow-up was 23 months. There was no difference in the overall, loco-regional, and distant recurrence rates between the three groups. A subcentimeter distal resection margin does not influence loco-regional or distant recurrence rates following sphincter preserving surgery for middle and lower third rectal adenocarcinoma.

Haemangiomas are one of the most common benign tumours. Clinicians come across haemangiomas of different subtypes at different locations in the body. They are often faced with the question of whether to treat them or leave it to the natural history of the disease. We present a case of the intramuscular variety of haemangioma found in the unusual location of the tongue in a 60-year-old woman. Fine needle aspiration was inconclusive and on magnetic resonance imaging, it mimicked a malignancy, which prompted treatment. We also review the unique pathology of this variety of haemangioma, which defines their treatment. The radiological attributes of the disease and recurrence rates of surgery are also discussed. Case HistoryA 60-year-old woman presented to us with swelling in the dorsum of the tongue that she had had for 5 years (Fig 1). The swelling was well defined, 4cm  3cm in diameter and soft to firm in consistency, non-compressible, nonmobile with no restrictions to the mobility of the tongue. Fine needle aspiration (FNA) of the swelling revealed only acellular fluid. Magnetic resonance imaging (MRI) showed a lesion that was hypointense on T1 weighted sequences and hyperintense on T2 weighted sequences with postcontrast enhancement. The lesion had irregular margins but there was no invasion of the base of the tongue or floor of the mouth and it did not cross the midline (Fig 2). However, the MRI did not give a definitive diagnosis.Owing to the diagnostic dilemma, we opted for surgical excision. The routine investigations (including haemoglobin, differential blood counts, platelets and coagulation profile) were normal. The lesion being small and accessible, the patient was operated in a day-case setting under general anaesthesia with nasal intubation. Since MRI did not reveal any proximity to vessels and the bleeding profile was normal, bleeding was unexpected. Surgical excision was performed with wide margins and the cavity was closed primarily with absorbable sutures along the long axis of the tongue.The procedure was uneventful, and the patient was discharged and called for follow-up visits on the third and tenth postoperative days. Histopathology revealed non-keratinised stratified squamous epithelium of the tongue and a nest of cells termed von Ebner's serous glands of the tongue. A magnified view of the staining results showed the 'pseudoinfiltrative' pattern of the intramuscular haemangioma (Fig 3). DiscussionHaemangiomas of skeletal muscle represent 0.8% of all benign vascular neoplasms.1 Of these, 13.8% occur in the head and neck region, with the masseter muscle being the most common site, followed by the trapezius and sternocleidomastoid muscles respectively. 2 A variety of tumours can be confused clinically with an intramuscular haemangioma (IMH), and the differential diagnoses include salivary neoplasms, cysts, lymphangiomas, rhabdomyosarcomas and schwannomas.Haemangiomas can have varied histology with capillary and cavernous haemangiomas being the most common. They are never encapsulated. A...

Background:Biological markers that reliably predict clinical or pathological response to primary systemic therapy early during a course of chemotherapy may have considerable clinical potential.Aims:Aims of study to evaluated changes in Ki-67 (MIB-1) labeling index and apoptotic index (AI) before, during, and after neoadjuvant anthracycline chemotherapy in breast cancer in Indian women.Materials and Methods:Breast cancer tissues were collected from Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India. Twenty-seven patients receiving neoadjuvant FEC (5-fluorouracil, epirubicin, and cyclophosphamide) chemotherapy for operable breast cancer underwent repeat core biopsy after 21 days of treatment.Results:The objective clinical response rate was 56%. Eight patients (31%) achieved a pathological response by histopathological criteria; two patients had a near-complete pathological response. Increased day-21 AI was a statistically significant predictor of pathological response (p = 0.049). A strong trend for predicting pathological response was seen with higher Ki-67 indices at day 21 and AI at surgery (p = 0.06 and 0.06, respectively).Conclusion:The clinical utility of early changes in biological marker expression during chemotherapy remains unclear. Until further prospectively validated evidence confirming the reliability of predictive biomarkers is available, clinical decision-making should not be based upon individual biological tumor biomarker profiles.

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